Individual
JAMIE ELISE WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1332 PARK ST STE 202, ALAMEDA, CA 94501-4545
(510) 523-3417
(510) 521-1659
Mailing address
1332 PARK ST STE 202, ALAMEDA, CA 94501-4545
(510) 523-3417
(510) 521-1659
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G79903
CA
2080B0002X
Pediatric Obesity Medicine Physician
G79903
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912186834
—
CA
Enumeration date
02/16/2007
Last updated
07/24/2023
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